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Five years ago, phone calls and paper records defined much of South Carolina's health care disaster preparedness. But once federal anti-bioterror preparedness funding began flowing in 2002, the migration to electronic communications began.

Now, doctors at 66 hospitals in the state can use a robust, Web-based, interactive tool to help them diagnose uncommon diseases such as smallpox and rabbit fever.

Web pages track the number of available hospital beds in the state, information that can be updated minute by minute during a disaster. And a new, statewide, geographic database application can be customized to send alerts to people in crisis-affected areas.

Those applications, and several others, have been funded in part by South Carolina's share of about $1.3 billion allocated each year to states for bioterror preparedness since the Sept. 11, 2001, terrorism attacks and mid-September 2001 anthrax attacks.

"South Carolina places a high premium on technology and its uses to benefit the people of our state," said Jim Beasley, a spokesman for the South Carolina Health and Environmental Control Department.

The money for state health preparedness comes primarily from the Centers for Disease Control and Prevention, which delivers grants to public health departments, and the Health Resources and Services Administration, which administers hospital bioterror preparedness funding.

For fiscal 2007, House and Senate legislation for the Labor-Health and Human Services-Education appropriations provides $824 million for public health systems and $487 million for hospital preparedness.

The final bill is awaiting passage, however.

Additional money is available for national bioterror initiatives, including $25 million for BioSense, which tracks health conditions in several cities and regions to get early warnings of possible attacks.

Want it? You got it

Federal preparedness dollars are still fairly abundant, though the amounts have decreased since the peak of $3 billion allocated in fiscal 2003.

And Congress has designated some of the funding for specific goals such as vaccinating care providers against smallpox, increasing pandemic flu preparedness and building hospital capacity to accommodate surges in patients. But substantial funding remains available.

Initially, hospitals bought equipment such as decontamination kits, protective suits and ventilators. Now a significant share of the money is going for IT projects, which are generally diverse and vary from state to state, according to Pat Libbey, executive director of the National Association of County and City Health Officials.

Libbey said some IT projects funded by federal health preparedness dollars include:

Syndromic surveillance

Bed-tracking systems

Geographic information alert systems

Web-based disease diagnostic tools

Logistics systems for asset tracking

School-based disaster databases

Radio and communications systems

Public health information-sharing.

"IT has been an issue from the beginning," he said. "My sense is that the money is being spread out and not concentrated on one thing."

A recent Association of State and Territorial Health Officials' report focused on several of those IT projects. The nation's "tremendous investment" in public health preparedness has included spending on surveillance capacities and communication and information networks, as well as epidemiological capacities, planning, labs and surge capacity, according to the group's Oct. 27 report, "States of Preparedness."

States take action

Many state health departments are actively pursuing projects.

In addition to the geographic database, diagnostic tool and bed-tracking system, South Carolina also has set up a Web-based, reverse 911 system to alert the public of an emergency anywhere inside its borders.

A statewide, 211 call project with United Way aims to develop a system to let citizens quickly get health information in an emergency.

"We learned how significant this type of system can be during the tragic train derailment and resulting chemical release in Graniteville, S.C., in January 2005," Beasley said.

More than 5,000 people were evacuated following that derailment, but there was criticism about whether all residents received timely information. Deployment of the alert system is expected in early 2007.

In another project, the Carolinas Health Electronic Surveillance System lets hospitals, labs and other providers send daily reports on incoming patients to a central repository.

For instance, if a large number of patients suddenly start appearing at hospitals with acute and unusual respiratory ailments, it could signal a bioterror attack or impending flu pandemic.

Such systems are termed as syndromic surveillance, because they monitor patients' symptoms, such as high fevers, severe coughs and vomiting, rather than rely on diagnoses of identified diseases, which take time and testing to confirm.

In addition, South Carolina health care providers have linked their networks to the state intelligence fusion center, operated by law enforcement officials, to share information on possible public health components related to anti-terrorism activities, Beasley said.

Others hard at work

In Missouri, state health officials focused on school preparedness by creating a secure, interactive, Web-based tool to help them plan for emergencies.

Officials throughout the state may upload floor plans, emergency plans and utility shutoff locations, along with other information, said spokeswoman Mary Kay Hager of the Missouri Health and Senior Services Department.

Utah has, in part, spent its federal health preparedness dollars on its Wireless Integrated Network, which bridges different radio frequencies to facilitate communications.

The Utah Health Department has signed an agreement with the state's IT Division to use the network, spokeswoman Charla Haley said.

In the District of Columbia, hospitals have made plans to use federal preparedness dollars to migrate to a Web-based system to track available beds and supplies.

But a lack of adequate funding may push back that system's implementation by months, said Dr. Jeff Elting, medical director of the D.C. Hospital Association.

Meanwhile, Elting said, the hospitals will continue to use the mutual aid radio system.

"To get everyone on one system could cost tens of millions of dollars," Elting said. "We have a ways to go in communications technology."

Much of CDC's preparedness funding has gone for public health alert systems and surveillance IT systems, said David Aylward, executive director of the ComCare Alliance, a national, nonprofit advocacy group for improved emergency communications.

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